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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Historic moments in the development of world health care

Filed Under (Health Improvement, Health Policy, USA) by Paul on 22-03-2010

It’s rare for one of my posts to be written through tears (although of course that doesn’t mean that many of you don’t end up reading them that way!) but by a quirk of history I am in America on the same day that President Obama’s Health Care Bill is passed.

The excitement of this comes from several sources.

Firstly and most significantly, this will extend coverage to tens of millions who have lost their health insurance through unemployment – in the US most employed people and their families are insured through their employers. When we lose our jobs in the UK it’s a big tragedy, but we still keep our health care. When someone loses their job in the US they and their family lose their health insurance. This means they often have no cover for illness at all. Given the high level of unemployment at the moment this is a big issue.

The second issue is the behaviour of the Republican Party. When I was a child in the 1950s the Conservatives saw themselves as the natural party of government and felt that when they lost elections – which in those days did not happen very often- they did so in a fit of absent mindedness. I remember the shock when Labour leader Harold Wilson said that the Labour Party was the natural party of Government- because this took the mantle away from the Conservatives.

In the US the Republicans feel that they have had power stolen from them by fraud. In 1992 when Bill Clinton won his first election they declared war upon his Government. For 8 years they were destabilising every aspect of that Government.

They are now doing the same to President Obama. They are in an attack frenzy and the only way they can keep this going is by representing everything that the President does as an extreme assault upon the American way of life.

So for them this health care Bill would destroy America. They are saying every day, in every media that they own or can buy, that extending health care coverage to people who cannot afford to pay for it out of their own pocket will destroy the American way of life. They have said that so often that they now believe it.

That means that a little matter of the electorate electing a President on a mandate, that mandate being put to the test in an elected Parliament, and then the Bill being passed there, all mean absolutely nothing.

Having lost the election they declare war on the new President. Having lost the vote for the health reform Bill they declare war on the new law. They, and their states, will not recognise it. They and their states will not allow the writ of the President to run.

So the passage of the Bill is a heavy defeat for them (hooray hooray) but that means they gear up to destroy and humiliate anyone who tries to implement it.

And the great thing for us NHS Brits is that for very odd reasons they decided to demonstrate how bad Obama’s health care reform was by saying that it was like the NHS. Post readers last August will remember that they got an obscure Conservative Member of the European Parliament to say that the NHS was a 60 year mistake. He has become a hero of the Republican right over here and I am sure if there was an equivalent of a Republican knighthood he would get one. He is still being quoted over here – as recently as Thursday’s Wall Street Journal.

The fact that David Cameron had to slap him down for the sake of UK Conservative politics passes the Republican right by.

So the NHS is wrapped into this struggle in a big way. For me that means when President Obama wins his health care Bill he not only beats frenzied Republican right wingers but he beats the enemies of the NHS.

Over the last decade the NHS has politically disempowered its enemies in the UK. They still exist. Most people who run the media are bewildered by a health care system that is open to all irrespective of their ability to pay, but none of these enemies have any political representation. There is not one political party that will attack the NHS. They know it will lose them votes (In the interest of accuracy I have just been onto the UKIP web site and their health policy is “Delivering better care, safeguarding the NHS” so they are in the fold too – and before you look up the BNP they are great NHS supporters).

I am very happy to have been in the US when their President manages to beat the enemies of the NHS here as well.

Comments:

One Response to “Historic moments in the development of world health care”


  1. It was a bold commendable move by Obama. The US almost have an advantage coming from a market-dominated system in that there will be less resistance to competition in the publicly funded sector. One of the dangers we have faced in the UK has been that although market reforms are necessary to encourage innovation and efficiency in the NHS, there is a (quite justified) fear that they will be used to slip privatisation in the back door: a system that has supply chain management infrastructure (i.e. patient level costing, payment by results, etc) could be moved away from public funding far more easily than one that doesn’t.

    I know that you’ve recently criticised politicians of all colours for putting populist policies (e.g. “save our A&E”) before giving PCTs the final say on how they commission services. That’s because we’ve had 60 years of free healthcare that we live in fear of losing, so it isn’t going to change soon (remember Wyre Forest). I am amused by the irony that in a few years time we may end up looking to the US as a good example of a publicly funded market-based system.

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